ABSTRACT
Transient abnormal myelopoiesis (TAM) is observed in a few neonates with Down syndrome. While a large proportion undergo complete remission without any treatment, some of them can develop myeloid leukemia of Down syndrome (ML-DS) in the future. Without proper treatment, mortality can be high. Here we have described an interesting and difficult-to-treat case of a neonatal with Down syndrome who presented with anemia, thrombocytopenia, and 75% blasts. We came across multiple challenges in treatment due to severe pneumonia.
ABSTRACT
Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36-1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion.
ABSTRACT
A full-term male baby was administered furosemide and enalapril for treatment of cardiac failure secondary to a ventricular septal defect. He also received piperacillin-tazobactam and amikacin for 7 days for suspected early-onset neonatal sepsis. He developed anuria and raised creatinine and was referred with acute kidney injury (AKI)-neonatal KDIGO (Kidney Disease Improving Global Outcomes) stage 3 on day 20. Urine output and renal parameters improved after discontinuing drugs and peritoneal dialysis. This case report highlights the importance of serial monitoring of kidney function tests while using nephrotoxic drugs and ensuring correct dosage and titration. In the early stages, AKI can be treated with conservative therapy but once established, renal replacement therapy might be required. It can also lead to chronic kidney disease.
Subject(s)
Acute Kidney Injury , Renal Dialysis , Infant, Newborn , Male , Humans , Renal Dialysis/adverse effects , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Creatinine , Renal Replacement Therapy , Iatrogenic Disease , Retrospective StudiesABSTRACT
Meconium peritonitis (MP) presenting as hydrops is a rare entity. A 34-week hydropic infant was born to mother diagnosed with a case of nonimmune hydrops. Postnatally, the neonate was diagnosed as a case of MP based on clinical examination and investigations. The neonate underwent exploratory laparotomy which revealed diffuse MP with ileal perforation. She underwent resection of ileal perforation with ileocolic anastomosis. The index case highlights the importance of thorough clinical examination and abdominal X-ray in the diagnosis of MP.
ABSTRACT
Introduction: Acinar cystic transformation (ACT) of the pancreas is characterized by multiple cysts lined by dual ductal and acinar-type of epithelium. ACT is typically a disease of adulthood and has not been described in a neonate. Case report: Autopsy of this term 3-day old male demonstrated cystic transformation of the entire pancreas measuring 42 mm in its largest dimension. The main pancreatic duct was patent. The numerous variable-sized cysts were lined by both ductal (CK7-positive) and acinar (trypsin-positive) epithelium. Congenital hemochromatosis of the liver, complete proximal jejunal atresia, gangrene of the post-atretic jejunum, and subglottic stenosis were associated features. Discussion/Conclusion: ACT may occur in the neonate in association with other abnormalities.
